What is the treatment for a burning acneiform rash?

From the Guidelines

For a burning acneiform rash, I recommend starting with gentle cleansing using a mild, fragrance-free cleanser like Cetaphil or CeraVe twice daily, and applying a topical treatment containing benzoyl peroxide (2.5-5%) or salicylic acid (1-2%) to affected areas once or twice daily, as supported by the most recent guidelines 1.

Treatment Approach

The treatment approach for a burning acneiform rash should prioritize reducing inflammation and bacterial infection.

• Gentle cleansing with a mild, fragrance-free cleanser is essential to prevent further irritation.
• Topical treatments such as benzoyl peroxide or salicylic acid can help reduce bacteria and inflammation.
• For inflammation and burning sensation, over-the-counter hydrocortisone cream (1%) can be used for up to 7 days.

Moistizer and Sunscreen

• Keeping the area moisturized with a non-comedogenic, oil-free moisturizer is crucial to prevent dryness and further irritation.
• Avoiding direct sun exposure on the affected areas and using non-comedogenic sunscreen when outdoors can help prevent further inflammation.

Consultation and Further Treatment

• If the rash is severe or doesn't improve within 1-2 weeks, consulting a dermatologist is recommended, as they may prescribe stronger treatments like topical antibiotics (clindamycin, erythromycin), prescription-strength retinoids, or oral antibiotics 1.
• Avoid picking or scrubbing the rash, and discontinue use of any potentially irritating skincare products or makeup, as this can exacerbate the condition.

Evidence-Based Recommendations

The recommendations are based on the most recent and highest quality studies, including the guidelines for the management of acne vulgaris 1, which provide strong recommendations for benzoyl peroxide, topical retinoids, and topical antibiotics, as well as conditional recommendations for other treatments.

• The guidelines also emphasize the importance of limiting systemic antibiotic use and combining topical therapies with multiple mechanisms of action 1.

From the FDA Drug Label

INDICATIONS AND USAGE: Erythromycin Topical Solution is indicated for the topical treatment of acne vulgaris. DOSAGE AND ADMINISTRATION: Erythromycin Topical Solution should be applied over the affected areas twice a day (morning and evening) after the skin is thoroughly washed with warm water and soap and patted dry. The treatment for a burning acneiform rash may be topical erythromycin applied twice a day, as it is indicated for the treatment of acne vulgaris 2. However, it is essential to follow the instructions and precautions provided by the physician and the drug label to minimize potential irritancy effects and antibiotic-resistant organisms 2 2.

From the Research

Treatment Options for Burning Acneiform Rash

• Topical antimicrobials such as clindamycin and erythromycin can be used to treat acneiform rash, as they work through both antimicrobial and non-antimicrobial mechanisms 3.
• Combination therapy with topical retinoids, benzoyl peroxide, or azelaic acid can enhance the efficacy of treatment and reduce resistance to antibiotics 3, 4.
• Benzoyl peroxide is a cost-effective topical treatment for acne, with a concentration of 5% being sufficient for controlling acne of grades I to II, but it can cause side effects such as burning, erythema, and desquamation 5.
• Adapalene and benzoyl peroxide combination therapy can synergistically regulate innate immunity and prevent lesion formation, making it a preferred approach for treating moderate to severe acne 6.
• Maintenance therapy with adapalene and benzoyl peroxide can prevent relapse and reduce disease symptoms in patients with severe acne 6.

Considerations for Treatment

• The emergence and spread of resistance among propionibacteria to antibiotics such as erythromycin and clindamycin calls into question their long-term viability as topical anti-acne therapies 3.
• Topical antibiotics should not be used as monotherapy, as this can lead to the development of gram-negative folliculitis and reduce efficacy 5.
• Combination formulations with benzoyl peroxide can reduce bacterial resistance and enhance efficacy 5.
• Newer approaches to treatment, such as topical dapsone, taurine bromamine, and resveratrol, may offer alternative options for patients with acneiform rash 7.